What is Acute Mastoiditis?
Acute mastoiditis was once common, but today is rare, and may seldom be seen by younger doctors. However, cases may still occur, and it is mentioned because if it does happen, treatment is essential to preserve hearing and prevent serious complications.
The mastoid is the bony knob behind the ear, filled with spongy cells. Nearly always an acute otitis media precedes mastoid infection, which represents a direct extension of the infection.
Acute Mastoiditis Symptoms
There is a history of ear infection. Pain following this is the cardinal sign. After an acute otitis has been treated (either by antibiotics, or bursting of the drum or myringotomy), pain usually subsides. If the pain continues or worsens after this, it could indicate mastoid infection. The pain is usually worse over the mastoid bone behind the ear rather than actually in the ear.
There is often an ear discharge tending to become more profuse. Sometimes it might cease, as pain increases.
This indicates that the canal has become blocked and the pus is damming up in the mastoid space.
Invariably there is a rise in temperature as the infection advances. Sharp rises indicate further complications. The pulse rate is an even more reliable guide to the advancement of this condition. Usually there is increasing deafness. The patient often feels and looks toxic and ill, is flushed and feverish and has a coated tongue.
The mastoid bone is tender if pressed and there is often swelling over it. The eardrum is frequently perforated, allowing pus to escape. Sometimes to assist diagnosis, X-rays of the mastoid are taken.
Acute Mastoiditis Treatment
This has radically altered over the past several years since antibiotics came into wide use. Now the disease is relatively rare and cases seldom advance to this stage, having been effectively nipped in the bud under treatment of the acute otitis.
However, if it does advance to a severe mastoid infection, the ENT surgeon may still operate, using the Schwartze operation. This allows complete drainage of the mastoid space, prevents further extension of infection and preserves hearing.
If hearing is lost over a period of time, it is most likely irreversible. The longer an infected mastoid is permitted to drain through the middle ear, the greater is the risk of permanent hearing impairment.
Results of the operation are usually excellent and, according to an authority on the subject, “barring accidents and neglect, results should approach 100 per cent. In children the results are naturally superior to those obtained in adults.” The poorest results are in adults in whom deafness either of middle ear or of sensori-neural type has previously been present.